Lack of individual advice for skinny T2D

[Nuttymichelle]

Does anyone feel a little isolated and frustrated for the lack of information for skinny type 2s.

I feel that I am being treated in the same way as a lifestyle type 2 and although I appreciate that high blood sugars are the same outcome I feel I need access to more specialised dietary and lifestyle advice.

I am within a healthy weight and BMI and all my blood markers are healthy apart from the HBA 1C.

I exercise regularly and definitely well within suggested healthy margins and my diet is pretty sound - according to the diabetic nurses. I am unsure of how much metformin and statins will improve my situation as I may not have much insulin resistance. There is very little advice that can be offered to me specifically on this other than 'try it and see' and ' you need to take the medication as soon as possible to have the best long term outcomes' - if you are already in shock about having type 2 diabetes and have been told that it is probably more 'genetic' (my father has 'skinny' type 2) then surely this merits more testing to check that the standard approach is the right one for you. I also do not like the idea of suddenly taking medication for the rest of my life when seemingly everything seems pretty ok apart from the blood sugars.

Basically, I don't feel that my personal situation is being considered in the advice I have been given and find it unhelpful and frustrating to be given general advice about loosing weight, changing diet and exercise when I am effectively already living within the guidelines. Apparently approximately 10% of T2D sufferers come under this 'skinny' bracket and I feel that some further procedural testing and/or specialist advice would be very helpful.

It would be great if skinny type 2s were given a completely different category (perhaps not called diabetic at all) and hopefully result in a different way of dealing with us as regards access to advice and services.

Anyone else feeling a bit angry and as though their true needs are not being met?

 

[HSSS]

Nope. I’m frustrated for most all of us, not just skinnies.

The “lifestyle” label is what the media and many medics portray though, as loathsome as it seems to those of us that werent fat, junk food swilling, sofa surfing slobs as they would have us all believe t2 all are. Neatly forgetting it’s not so simple and t2 diabetes makes you fat as much as the other way around. And sadly it’s a sentiment echo’d by many newly diagnosed t2 in here as that’s how they’ve been thus far “educated” - til they are here a while, and see it differently. And the standard advice is critiqued by many here, skinny or not.

I do kind of agree that in situations like this further testing should be warranted to be sure it’s not a LADA, or mody for example and don’t necessarily agree with the earlier you medicate the better your odds, neither does NICE. What happened to lifestyle changes first? A recognised side effect of statins is to raise blood glucose in some. If your bloods are all normal what was the rationale behind being prescribed statins? What was your hba1c? Very high or just into diagnosis levels? That will affect the medication pathway recommended, as should your personal preferences.

Certainly being within the questionable bmi ranges and active is no guarantee it’s not type 2 though. Prof Taylor for example proposes we each have a personal fat threshold and potentially even skinny toe 2 may be above theirs depending where in their body their fat is held. There’s a phrase TOFI you might want to look at. Thin outside fat inside that’s relevant to his position. There’s also a significant number of us that feel the standard advice such as you appear to have been given is lacking. It very much depends if it’s an improvement on your starting point or not and if it’s not then you need to find a better way for you. Some nurses are more open to a more flexible approach. Others aren’t.

Many in here, whatever their weight, follow a lower carb approach successfully to manage their type 2. It doesn’t have to mean weight loss if you replace ditched carbs with more proteins and healthy fats. The nhs recognises this approach, even fund it in some areas and there’s a growing number of practices that actively promote it.

 

[Melgar]

Welcome to the forum @Nuttymichelle . I certainly hear you. It is very frustrating
The whole darn T2 diagnosis is messed up, in my opinion.
I love Mediterranean food, I don’t drink, I don’t smoke, I’m thin, I have a BMI of 19. I’m very fit, but have problems with my blood sugar. My C-peptides are low/normal. My weight drops off if I miss a couple of meals.

I don’t fit the TOFI definition, nor I suspect do a number of struggling individuals that make up that small cohort of lean diabetics. Are we simply outliers, confined to a sub category and ignored. If HCPs do investigate further would there be other reasons that don’t fall neatly into the insulin resistance / pancreas can’t cope

C- peptides should be tested along side lipids. It’s not an expensive test. When I look at my blood panel there are tests in that panel that seem to have no real bearing on anything, yet a C-Peptide test will tell you the state of your pancreas, how well your body is dealing with the types of food you eat , how bad or if You even have insulin resistance. it literally opens the window on the state of your pancreas. Instead we get meaningless sound bites, oh you are T2 because the majority of diabetics are T2, as we have diagnosed you as T2 we therefore know you are insulin resistant. We don’t actually know you have insulin resistance but because we think you are T2 you obviously have Insulin Resistance.

My view is this, and I stress it is a personal view, a diagnosis is simply a set of common symptoms that can be grouped together and given a name so HCPs can identify and treat it. The diagnosis has been created so we can treat the symptoms and the cause of those symptoms. What happens, however, when that diagnosis works for, say only 85-90% of those with same raised blood sugar symptoms, but not the other 10-15%. What happens to those people. What happens when low carb ing, weight loss and exercise doesn’t reduce those blood sugars. What happens when T2 blood lowering meds stop working. Firstly, the HCP May assume the patient is somehow cheating, lying even. They don’t assume their diagnosis is wrong or a T2 diagnosis is too broad. The D2 category is too broad and effectively a T2 diagnosis literally stops any investigation into what else can be causing those raised blood sugars.

 

[AloeSvea]

Yeah - the 'lifestyle type two diabetes' was a new one on me too!

Goodness! It came across precariously similar to fat shaming in metabolic disease. I'm sure that is not how it was meant?

I think individualised treatment is a luxury in diabetes healthcare generally, sadly. It is wonderful when you can get it.

 

[ianf0ster]

Personally I found plenty of advice for skinny T2's such as I am/was:

Dr David Unwin's original .pdf about his successes with a Low Carb High Fat diet - Which has a high rate of remission still persisting after several years (only 4yrs so far) in my case, but I have heard of some using the earlier 'Atkins' version with over 10yr drug free remission.

Dr Michael Mosely's low carb versions of his popular blood sugar diet books.

All the Low Carb and BG testing advice in both this forum and now also in the DUK forum.

The Freshwell GP Practice Low Carb website and app.

The UK based Public Health Collaboration

Various international Low Carb doctors and organisations.

Lastly, you may believe that you are eating healthy, but if you are eating healthy as my GP, the NHS, most governments and dietician advise, then you're probably eating the same way I did for decades and which eventually led me to becoming Type 2.
Eating 'Healthy for your personal form of Type 2' is very much the opposite of what is promoted as healthy for a healthy person and needs to be individualised, so we have to work on that for ourselves- if we think we are worth it!

 

[OrsonKartt]

Does anyone feel a little isolated and frustrated for the lack of information for skinny type 2s.

I feel that I am being treated in the same way as a lifestyle type 2 and although I appreciate that high blood sugars are the same outcome I feel I need access to more specialised dietary and lifestyle advice.

I am within a healthy weight and BMI and all my blood markers are healthy apart from the HBA 1C.

I exercise regularly and definitely well within suggested healthy margins and my diet is pretty sound - according to the diabetic nurses. I am unsure of how much metformin and statins will improve my situation as I may not have much insulin resistance. There is very little advice that can be offered to me specifically on this other than 'try it and see' and ' you need to take the medication as soon as possible to have the best long term outcomes' - if you are already in shock about having type 2 diabetes and have been told that it is probably more 'genetic' (my father has 'skinny' type 2) then surely this merits more testing to check that the standard approach is the right one for you. I also do not like the idea of suddenly taking medication for the rest of my life when seemingly everything seems pretty ok apart from the blood sugars.

Basically, I don't feel that my personal situation is being considered in the advice I have been given and find it unhelpful and frustrating to be given general advice about loosing weight, changing diet and exercise when I am effectively already living within the guidelines. Apparently approximately 10% of T2D sufferers come under this 'skinny' bracket and I feel that some further procedural testing and/or specialist advice would be very helpful.

It would be great if skinny type 2s were given a completely different category (perhaps not called diabetic at all) and hopefully result in a different way of dealing with us as regards access to advice and services.

Anyone else feeling a bit angry and as though their true needs are not being met?

I’m a skinny too. BMI of around 19 . I eat strictly very low carb, ketovore. I can keep my hba1c to just below diabetic. -

- I read everything I can find on diabetes and have done since diagnosis around 8 years ago
I often find I’m better informed than the diabetic nurses in the system.

It’s tough that when you are your weakest you have to be your strongest.

Best thoughts

 

[OrsonKartt]

Oh yea. Since eating this way my cholesterol has significantly increased so I had to inform myself on this too

Currently I take no medication

 

[OrsonKartt]

The D2 category is too broad and effectively a T2 diagnosis literally stops any investigation into what else can be causing those raised blood sugars.[/QUOTE]


Around 8 years ago I paid for my own c-peptide which was on the low side of normal. It cost around £300 and I had to drive over an hour to get the test done

Over this time frame my dietary control has year by year been stricter and yet my hba1c has increased . Currently 47

From my experience there is very little professional curiosity

 

[ianf0ster]

Oh yea. Since eating this way my cholesterol has significantly increased so I had to inform myself on this too

Currently I take no medication

You don't mention the specific levels of lipids, but from what people have self reported:
Overweight and obese T2D's on low carb tend to improve ALL their lipids (HDL up, LDL down, Triglycerides down) while those who start off as under or normal weight going onto low carb tend to find their HDL and Triglycerides improve but their LDL increases.

Even before hearing about 'lean mass hyper-responders' I didn't worry about my high LDL because I reasoned that low carb made me healthier in so many different ways, it seemed questionable that I should take steps to become less healthy in those areas merely because my LDL rose on Low Carb in contrast to the vast majority for whom it reduced while eating the same foods.

 

[OrsonKartt]

You don't mention the specific levels of lipids, but from what people have self reported:
Overweight and obese T2D's on low carb tend to improve ALL their lipids (HDL up, LDL down, Triglycerides down) while those who start off as under or normal weight going onto low carb tend to find their HDL and Triglycerides improve but their LDL increases.

Even before hearing about 'lean mass hyper-responders' I didn't worry about my high LDL because I reasoned that low carb made me healthier in so many different ways, it seemed questionable that I should take steps to become less healthy in those areas merely because my LDL rose on Low Carb in contrast to the vast majority for whom it reduced while eating the same foods.

- were you told about this by a medical practitioner?

Unless I am mistaken The original poster is confused by the lack of information when diagnosed

I agree about your observations from n=1 sources however with some notable exception this is not the prevailing medical practice- at least not in my experience

 

[ianf0ster]

- were you told about this by a medical practitioner?

Unless I am mistaken The original poster is confused by the lack of information when diagnosed

I agree about your observations from n=1 sources however with some notable exception this is not the prevailing medical practice- at least not in my experience

I'm not sure which part you mean about being told by a medical practitioner.

The advice/information I got from my GP was just as lacking as with most people. However. after I found material from Dr David Unwin, Dr Michael Mosely and Prof Roy Taylor he did (at least partially) confirm it. He also said in his experience almost nobody could follow it and so he didn't advise his patients of it.
When I asked about which was bast of the 3 methods he plumped for Dr Michael Mosely's because it was the newest. This lead me to choose Dr David Unwin's Low Carb, because being slim I didn't fancy starving myself and I recognised that although supposedly a 'diabetes specialist GP', he probably knew less than me about the relationship between T2D, body fat, diet, insulin and blood glucose by then.

 

[ianf0ster]

Various Doctors who specialise in Low Carb for weight loss and diabetes have 'agreed/confirmed' (on Twitter, YouTube etc.) that their experience matches what I have deduced from my own searches. For what that's worth.

To get the thread back on track @Nuttymichelle while there still few medical practices which provide good information and advice to the majority of T2's, it isn't yet reasonable to expect that the average practice cater well for atypical skinny T2's. But the evidence out there is growing that it does indeed work at least as well as drugs.

 

[Jo123]

I've got a bmi of 19.4 and was pre diabetic over 10 years ago, with a normal bmi then and a runner at that time. To be honest I don't think the advice is any better for overweight diabetics. Several I know personally are still being told it's fine to eat wholemeal bread, wholemeal pasta, pulses etc.

 

[carty]

Not quite on the same theme but I think that this is an idea how skinny type 2s are " helped " I was referred. to a dietician who sacked me because I was too thin !!!
Carol